Native Aortic Root Thrombosis After Norwood Palliation for Hypoplastic Left Heart Syndrome
| Autor: | Taufiek Konrad Rajab, Max B. Mitchell |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry medicine.medical_treatment Thrombolysis 030204 cardiovascular system & hematology medicine.disease Thrombosis Surgery Hypoplastic left heart syndrome 03 medical and health sciences Catheter 0302 clinical medicine 030228 respiratory system medicine Retrograde perfusion Stage (cooking) Cardiology and Cardiovascular Medicine business Complication Cardiac catheterization |
| Zdroj: | The Annals of Thoracic Surgery. 112:147-154 |
| ISSN: | 0003-4975 |
| Popis: | Background Norwood palliation for hypoplastic left heart syndrome typically results in retrograde perfusion of the native aortic root. This may predispose to native aortic root thrombosis (NART). Methods Patients who underwent stage 1 Norwood palliation at Children’s Hospital Colorado between 2003 and 2019 were retrospectively reviewed for NART. Additional patients were identified by a systematic literature review. Patient factors, operative details, presentation, diagnostic methods, treatments, and outcomes were analyzed. Results Three patients with NART were identified among 241 patients who had undergone stage 1 Norwood palliation at Children’s Hospital Colorado (mean follow-up, 48 months). A fourth patient identified at Children’s Hospital Colorado had undergone stage 1 palliation elsewhere. The systematic literature review identified 12 additional patients. Among the 16 patients, patients presented with new arrhythmias (38% [n = 6]), evidence of ischemia (31% [n = 5]), incidentally (19% [n = 3]), inability to wean from postoperative support (6% [n = 1]), and cardiac arrest (6% [n = 1). The diagnosis was made by transthoracic echocardiography (TTE) in 50% (n = 8), transesophageal echocardiography in 19% (n = 3), cardiac catheterization in 25% (n = 4), and cardiac computed tomography in 6% (n = 1). Importantly, 44% (n = 7) of patients were missed by TTE and subsequently diagnosed by other methods. Treatment strategies were surgical thrombectomy in 38% (n = 6), anticoagulation alone in 38% (n = 6), direct catheter thrombolysis in 19% (n = 3), and systemic thrombolysis in 6% (n = 1). The rate of mortality or transplant listing was 44% (n = 7). Conclusions NART is an underappreciated complication of Norwood palliation with high mortality. There should be a high index of suspicion for NART in patients after Norwood palliation with an unexplained complicated clinical course. Importantly, NART is frequently missed by TTE. |
| Databáze: | OpenAIRE |
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